A misplaced MRI found a tumor on her spine. Doctors removed it through her eye in a first-of-its-kind surgery.

CBS News

2 days ago

Karla Flores was 18 when she started experiencing double vision. She knew something was wrong but struggled to find a diagnosis. Finally, she saw an ophthalmologist who referred her to a neurosurgeon.
Flores, then 19, was diagnosed with a chordoma wrapped around her brain stem. Chordomas are incredibly rare — only about 300 are diagnosed per year in the United States, according to the Cleveland Clinic — and they are slow-growing, malignant tumors.
The tumor was putting pressure on multiple of Flores' cranial nerves, said Dr. Mohammed Labib, a neurosurgeon at the University of Maryland Medical Center who led her treatment. Labib developed a complex surgical plan that required two surgeries to remove the tumor without damaging the delicate nerves.
When Flores underwent an MRI the morning of the first surgery, the technician positioned the camera a little lower than necessary. When looking at the scans, Labib realized Flores had a second chordoma. This one was at the top of her spine, at the front of her spinal cord. It was wrapped around her spinal cord and had invaded the vertebrae in her neck, Labib said.
"They told me if they hadn't seen it, I could have been paralyzed," Flores told CBS News.
The two chordomas. Karla Flores was first diagnosed with a chordoma on her brain stem (the center red mass). She was then diagnosed with a second chordoma on her spinal cord (the lower red mass).
University of Maryland Medical Center
Despite the startling discovery, Labib decided to go ahead with the procedures to remove Flores' first chordoma. The tumor was successfully removed through a traditional neurosurgery and another procedure that went through Flores' nose.
In between the procedures, Labib studied the location of the second tumor. In most cases, he would make an incision in the spine to approach the tumor from the back, but the chordoma's location meant that wasn't an option. Going through Flores' nose again wouldn't give him enough space to operate. One colleague even suggested that there was nothing they could do.
"I spoke to colleagues, and one of them said 'You're not gonna cure her from this,' basically, maybe she should be more of a palliative care patient," said Labib.
Palliative care refers to making a terminally ill patient comfortable for their last days. "I wasn't very enthusiastic about that," Labib added.
Developing a unique surgical plan
Labib continued to study Flores' scans and look for ways to reach the second chordoma. While considering approaching it through her nose, he realized the cheekbone between her nose and eye was one of the obstacles blocking him from reaching the tumor. That gave him an idea: What if he approached through the side of Flores' eye?
He had done it for a surgery several years prior, but never to remove a spinal tumor. Labib spent weeks practicing the technique, which he called the "third nostril" approach, in UMMC's neurosurgery laboratory. He used cadaver heads and skull models to ensure that he could safely reach and operate on the tumor. He and other members of Flores' team spent weeks working through potential problems, including ensuring that they could create a surgical opening without damaging her eyeball and modifying surgical instruments so they would work for the procedure.
An illustration of the approach to Karla Flores' chordoma. The left line shows one of the obstacles presented by a nasal approach. The right line shows the "third nostril" approach Flores' surgeons used.
University of Maryland Medical Center
After he was confident in the approach, Labib told Flores and her family about the plan.
"Her mother cried. Karla was emotional. Her father, he's not an emotional guy, but you could see from his silence he was concerned," Labib remembered.
Flores said she trusted Labib and approved the surgery.
"I was scared I wasn't going to see my parents again, because you never know what's going to happen when you go inside the surgery," she admitted.
In the operating room, facial plastic and reconstructive surgeon Dr. Kalpesh T. Vakharia cut through the membrane that protects the eye inside the lower eyelid and removed the bottom of Flores' eye socket and a portion of her cheekbone. That allowed Labib to reach the operating site. It also left Flores with no external scars, Vakharia said.
Once the bones were removed, Labib and head and neck surgeon Dr. Andrea Hebert drilled through Flores' vertebrae to reach the tumor. They dissected it carefully, following the procedure they had developed in the lab. By the time they were done, the chordoma was entirely removed, Labib said.
"It was perfect," he said.
Once that was done, Vakharia rebuilt Flores' eye socket with a titanium plate and rebuilt her cheek with bone from her hip. The process took about 20 hours, Labib said.
"Each step is an accomplishment"
The chordoma was removed, but Flores still had more treatment to come. A spinal surgeon stabilized the vertebrae that had been affected during the surgery. Six weeks later, she underwent radiation treatment to ensure there was no cancer in her body. Nearly a year after completing treatment, Flores has no evidence of cancer.
The treatment was followed by rehabilitative therapy. Flores, now 20, struggles to move her left eye because of nerve damage from the chordoma, but is continuing to work on it in physical therapy.
Karla Flores and her cat, Sushi, in 2025.
Karla Flores
Flores said that when she is feeling better, she wants to go to school to become a manicurist. She has follow-up appointments at UMMC every few months. Her biggest struggle right now is medical bills: She said she owes about $600,000. A GoFundMe has raised just a few thousand dollars.
"I keep reminding myself to take one day at a time and know that each step is an accomplishment. I'm also glad I stood my ground and kept looking for help until I found it," Flores said in an emailed statement.
Labib said he hopes the procedure can be used to help operate on other difficult-to-reach tumors.
"I think this opens a new corridor for approaching tumors that are in the upper cervical (or high part of the) spine," Labib said. "I think this third nostril approach is a smaller, easier and cleaner approach, and I think it's going to really take on these difficult tumors in front of the spinal cord."